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Title 18 : Health
Chapter 231 : Advance Directives for Health Care, Disposition of Remains, and Surrogate Decision Making
Subchapter 001 : Advance Directives and Disposition of Remains
(Cite as: 18 V.S.A. § 9701)-
§ 9701. Definitions
As used in this chapter:
(1) “Advance directive” means a written record executed pursuant to section 9703 of this title, which may include appointment of an agent, identification of a preferred primary care clinician, instructions on health care desires or treatment goals, an anatomical gift, disposition of remains, and funeral goods and services. The term includes documents designated under prior law as a durable power of attorney for health care or a terminal care document.
(2) “Agent” means an adult with capacity to whom authority to make health care decisions is delegated under an advance directive, including an alternate agent if the agent is not reasonably available.
(3) “Anatomical gift” shall have the same meaning as provided in subdivision 5250b(3) of this title.
(4) “Capacity” means an individual’s ability to make and communicate a decision regarding the issue that needs to be decided.
(A) An individual shall be deemed to have capacity to appoint an agent if the individual has a basic understanding of what it means to have another individual make health care decisions for oneself and of who would be an appropriate individual to make those decisions, and can identify whom the individual wants to make health care decisions for the individual.
(B) An individual shall be deemed to have capacity to make a health care decision if the individual has a basic understanding of the diagnosed condition and the benefits, risks, and alternatives to the proposed health care.
(5) “Clinician” means a medical doctor licensed to practice under 26 V.S.A. chapter 23, an osteopathic physician licensed pursuant to 26 V.S.A. chapter 33, an advanced practice registered nurse licensed pursuant to 26 V.S.A. chapter 28, subchapter 2, and a physician assistant licensed pursuant to 26 V.S.A. chapter 31 acting within the scope of the license under which the clinician is practicing.
(6) “Clinician orders for life-sustaining treatment” or “COLST” means a clinician’s order or orders for treatment such as intubation, mechanical ventilation, transfer to hospital, antibiotics, artificially administered nutrition, or another medical intervention. A COLST order is designed for use in outpatient settings and health care facilities and may include a DNR order that meets the requirements of section 9708 of this title.
(7) “Commissioner” means the Commissioner of Health.
(8) “Do-not-resuscitate order” or “DNR order” means a written order of the patient’s clinician directing health care providers not to attempt resuscitation.
(9) “DNR identification” means a necklace, bracelet, or anklet identifying the patient as an individual who has a DNR order.
(10) “Emergency medical personnel” shall have the same meaning as provided in 24 V.S.A. § 2651.
(11) “Guardian” means a person appointed by the Probate Division of the Superior Court who has the authority to make medical decisions pursuant to 14 V.S.A. § 3069(c).
(12) “Health care” means any treatment, service, or procedure to maintain, diagnose, or treat an individual’s physical or mental condition, including services provided pursuant to a clinician’s order, and services to assist in activities of daily living provided by a health care provider or in a health care facility or residential care facility.
(13) “Health care decision” means consent, refusal to consent, or withdrawal of consent to any health care and includes consent to receive out-of-network services.
(14) “Health care facility” shall have the same meaning as provided in section 9432 of this title.
(15) “Health care provider” shall have the same meaning as provided in section 9432 of this title and shall include emergency medical personnel.
(16) “HIPAA” means the Health Insurance Portability and Accountability Act of 1996, codified at 42 U.S.C. § 1320d and 45 C.F.R. §§ 160-164.
(17) “Informed consent” means the consent given voluntarily by an individual with capacity, on his or her own behalf or on behalf of another in the role of an agent, guardian, or surrogate, after being fully informed of the nature, benefits, risks, and consequences of the proposed health care, alternative health care, and no health care.
(18) “Interested individual” means:
(A) the principal’s or patient’s spouse, adult child, parent, adult sibling, adult grandchild, or clergy person; or
(B) any adult who has exhibited special care and concern for the principal or patient and who is personally familiar with the principal’s or patient’s values.
(19) “Life sustaining treatment” means any medical intervention, including nutrition and hydration administered by medical means and antibiotics, which is intended to extend life and without which the principal or patient is likely to die.
(20) “Nutrition and hydration administered by medical means” means the provision of food and water by means other than the natural ingestion of food or fluids by eating or drinking. Natural ingestion includes spoon feeding or similar means of assistance.
(21) “Ombudsman” means:
(A) the State Long-Term Care Ombudsman or a representative of the Ombudsman’s Office, as defined in 33 V.S.A. § 7501; or
(B) a representative of the agency designated as the Office of the Mental Health Care Ombudsman pursuant to section 7259 of this title.
(22) “Patient’s clinician” means the clinician who currently has responsibility for providing health care to the patient.
(23) “Principal” means an adult who has executed an advance directive.
(24) “Principal’s clinician” means a clinician who currently has responsibility for providing health care to the principal.
(25) “Probate Division of the Superior Court designee” means a responsible, knowledgeable individual independent of a health care facility designated by the Probate Division of the Superior Court in the district where the principal resides or the county where the facility is located.
(26) “Procurement organization” shall have the same meaning as in subdivision 5250b(22) of this title.
(27) “Reasonably available” means able to be contacted with a level of diligence appropriate to the seriousness and urgency of a principal’s health care needs, and willing and able to act in a timely manner considering the urgency of the principal’s health care needs.
(28) “Registry” means a secure, web-based database created by the Commissioner to which individuals may submit an advance directive or information regarding the location of an advance directive that is accessible to principals and agents and, as needed, to individuals appointed to arrange for the disposition of remains, procurement organizations, health care providers, health care facilities, residential care facilities, funeral directors, crematory operators, cemetery officials, Probate Division of the Superior Court officials, and the employees thereof.
(29) “Residential care facility” means a residential care home or an assisted living residence as those terms are defined in 33 V.S.A. § 7102.
(30) “Resuscitate” or “resuscitation” includes chest compressions and mask ventilation; intubation and ventilation; defibrillation or cardioversion; and emergency cardiac medications provided according to the guidelines of the American Heart Association’s Cardiac Life Support program.
(31) “DNR/COLST” means a do-not-resuscitate order (DNR) or a clinician order for life-sustaining treatment (COLST), or both.
(32) “Surrogate” means an interested individual who provides or withholds, pursuant to subchapter 2 of this chapter, informed consent for a do-not-resuscitate order or a clinician order for life-sustaining treatment.
(33) “Suspend” means to terminate the applicability of all or part of an advance directive for a specific period of time or while a specific condition exists.
(34) “Mental health patient representative” means the mental health patient representative established by section 7253 of this title. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.), § 332; 2009, No. 25, § 13; 2009, No. 119 (Adj. Sess.), § 4; 2009, No. 154 (Adj. Sess.), § 238a, eff. Feb. 1, 2011; 2011, No. 60, § 9, eff. June 1, 2011; 2013, No. 34, § 30a; 2013, No. 127 (Adj. Sess.), § 4, eff. May 10, 2014; 2013, No. 192 (Adj. Sess.), § 17; 2015, No. 23, § 47; 2015, No. 136 (Adj. Sess.), § 1, eff. Jan. 1, 2018; 2017, No. 113 (Adj. Sess.), § 112; 2017, No. 121 (Adj. Sess.), § 1, eff. May 3, 2018; 2021, No. 137 (Adj. Sess.), § 7, eff. July 1, 2022.)
